How long does pain from an ankle sprain typically last?

Duration of Pain Following Ankle Sprains

Pain from an ankle sprain typically decreases rapidly in the first 2 weeks after injury, but 5-33% of patients may continue to experience pain and instability symptoms for up to a year after the initial injury. 1

Timeline of Pain and Recovery

Acute Phase (0-2 weeks)

• Pain is most intense during the first few days after injury
• Rapid decrease in pain occurs within the first 2 weeks 1
• PRICE protocol (Protection, Rest, Ice, Compression, Elevation) is recommended during this phase 1
• Cold application should be limited to 20-30 minutes per application, 3-4 times daily 1

Subacute Phase (2-6 weeks)

• Most patients experience significant improvement in pain and function
• Functional support (braces or tape) is preferred over immobilization for 4-6 weeks 1
• Pain that persists beyond 6 weeks may indicate inadequate rehabilitation or complications 2

Chronic Phase (>6 weeks)

• 72.6% of patients report some residual symptoms 6-18 months after injury 3
• 40.4% report at least one moderate to severe symptom, most commonly perceived ankle weakness 3
• 5-33% of patients still experience pain and instability at 1 year 1
• 3-34% experience recurrent ankle sprains within a year 1

Factors Affecting Pain Duration

Injury Severity

• Grade I (mild): Minimal pain and swelling, typically resolves within 1-3 weeks
• Grade II (moderate): Partial ligament tear with moderate pain, may take 3-6 weeks
• Grade III (severe): Complete ligament tear with significant pain, may take 6-12 weeks or longer 1

Negative Prognostic Factors

• Reinjury of the ankle (7.2 times higher risk of prolonged symptoms) 3
• Activity restriction longer than 1 week (2 times higher risk) 3
• Limited weight bearing longer than 28 days (2.2 times higher risk) 3
• High-level sports participation 1
• Inadequate rehabilitation 2

Treatment Approaches to Reduce Pain Duration

Early Mobilization

• Early mobilization leads to less pain at 3 weeks compared to immobilization (57% vs 87%) 4
• Allows earlier return to work and may be more comfortable for patients 4
• Functional treatment is superior to immobilization for reducing pain and improving recovery time 1

Exercise Therapy

• Exercise therapy initiated early can reduce recurrent injuries and improve outcomes 1
• Combination of manual therapy and supervised exercise leads to better recovery than home exercises alone 5
• Proprioceptive and neuromuscular exercises are particularly beneficial 1

External Support

• Semirigid or lace-up ankle supports are recommended as functional treatment 1
• Using an ankle brace shows greater effects compared with other types of functional support 1
• External supports should be used for 4-6 weeks following injury 1

Common Pitfalls and Caveats

• Persistent pain (>6 weeks) may indicate complications such as:

  • Inadequate rehabilitation
  • Impingement
  • Occult osteochondral lesions
  • Peroneal tendon injury
  • Syndesmosis injury
  • Lateral instability 2

• Failure to properly diagnose fractures can lead to prolonged pain

  • Use Ottawa Ankle Rules to determine need for radiography 1
  • Radiography indicated if pain in malleolar/midfoot zone AND either bone tenderness or inability to bear weight for four steps 6

• Immobilization for more than 10 days can lead to worse outcomes

  • If immobilization is used to treat pain or edema, it should be limited to a maximum of 10 days 1

• Inadequate rehabilitation increases risk of chronic instability and recurrent sprains

  • Exercise therapy should be incorporated into treatment plan 1
  • Manual therapy combined with exercise therapy provides better outcomes than exercise therapy alone 1

Remember that while most ankle sprains heal well with appropriate treatment, a significant percentage of patients experience prolonged symptoms that can affect quality of life. Early appropriate treatment and rehabilitation are essential to minimize long-term pain and disability.